School of Health Sciences (Health-Sciences) Collectionshttp://hdl.handle.net/10570/1822024-03-29T14:24:32Z2024-03-29T14:24:32Z30 day in-hospital patient mortality after ICU discharge and associated factors : a retrospective cohort study in selected tertiary hospitals in KampalaNantongo, Bettyhttp://hdl.handle.net/10570/88642021-09-02T12:27:33Z2021-01-25T00:00:00Z30 day in-hospital patient mortality after ICU discharge and associated factors : a retrospective cohort study in selected tertiary hospitals in Kampala
Nantongo, Betty
Background: Intensive care medicine is rapidly growing because critical illness is a major component of the global burden of disease especially in LMICs. We retrospectively evaluated the 30 day In-hospital patient mortality after ICU discharge and associated factors. Methods: We conducted a retrospective multicentre Cohort study on all patients that were discharged alive from the ICU at three tertiary hospitals in Kampala- Uganda, patient records discharged between January 2018 to December 2019 were reviewed during their hospital stay to fill the data extraction tool and followed up. In-hospital mortality after ICU discharge as primary outcome. Results: In total 711 patients were included with mean age of 42 years and 56.4% were male. A total of 106/711 patients died after ICU discharge giving a mortality of 14.9% (95% CI: 12.4-17.7). Most (86/711) patients died within the first 20 days with a 0.802 survival probability and were mostly above 40 years. The median number of hospital stay after ICU discharge 7 days (IQR: 5-11). Multivariate analysis identified presence of comorbidities, Respiratory disorder at ICU admission and GIT disorder at ICU admission and inotropic/vasopressor support to be associated with patient mortality after ICU discharge while Tracheostomy placement was found to be protective. Conclusion: The 30-day in hospital patient mortality rate after ICU discharge was high compared to that in high income countries. Most in-hospital patient deaths after ICU discharge occurred during the first 20 days. A prospective study is needed to further explore In-hospital patient mortality after ICU discharge and associated factors.
A dissertation to be submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirement for the award of the Degree of Masters of Medicine (Anaesthesiology) of Makerere University
2021-01-25T00:00:00ZAcceptance of routine counselling and testing for HIV among medical patients at Mulago Hospital casuality unit.Nakanjako, Damalie Khttp://hdl.handle.net/10570/10862015-01-07T08:40:24Z2005-07-01T00:00:00ZAcceptance of routine counselling and testing for HIV among medical patients at Mulago Hospital casuality unit.
Nakanjako, Damalie K
Introduction: HIV counseling and testing is an entry point to comprehensive HIVIAIDS prevention and care. In Uganda, VCT is available in ambulatory settings where clients present by self-selection. Routine Counseling and Testing for HIV (RCT) is not widely offered as part of medical care at Mulago hospital. Data on patient acceptability of RCT in an acute care setting is still limited in Sub-Saharan Africa and Uganda in particular. This study determined the acceptability of RCT and the patient factors influencing uptake of the service in a hospital Methods: This was a cross-sectional study. Participants were selected by systematic sampling of patients attending the medical casualty unit at Mulago Hospital; Interviews were conducted to determine whether patients knew their HIV serostatus. HIV counseling and testing was offered to all eligible patients and results were delivered within 30minutes. WHO clinical staging was performed for the HIV positive patients. Acceptability of RCT was measured by the proportion of patients that agreed to be tested for HIV. Bivariate analysis was done to determine the sociodemographic, socio-economic and medical factors affecting the acceptability of RCT. Results: One hundred ninety three out of 233 patients that came to the Mulago casualty unit between October and December 2004 (83%) were not aware of their HIV serostatus. One hundred seventy one out of the 193 (88%) had sought treatment at a health unit in the previous six months where HIV testing had not been offered. Seventy out of 17 1 (5 1%) who had sought medical care in the previous six months had been to both private and public health units. One hundred ninety eight out of 208 (95%) that were offered HIV testing accepted to test for HIV. The very high acceptability precluded analysis of the factors associated with decline to test for HIV. One hundred and eleven out of 223 (50%) study participants were infected with HIV and 86 of the 111 HIV infections (77%) were diagnosed during the study period. Seventy eight out of 111 HIV infected participants (70%) were in WHO clinical stage 3 and 4. No immediate psychological breakdown was observed following delivery of HIV positive results. Conclusions: Acceptability of routine HIV testing was high at the medical casualty unit at Mulago Hospital. RCT in this setting identified a significant number of HIV infected patients. RCT has a potential public health impact of increasing the number of HIV infections diagnosed and hence the number of persons with access to HIV/AIDS prevention and treatment services. We recommend that RCT should be adopted as standard of care for patients at the medical casualty unit at Mulago hospital and other private and public health units in Uganda in order to meet patients at their earliest contact with the health care system.
A thesis submitted in partial fulfillment of the requirements for the award of the Masters of Medicine in Internal Medicine Degree of Makerere University.
2005-07-01T00:00:00ZAccess to anti-hypertensive and anti-diabetic medications amongst people living with HIV in Soroti District, Eastern UgandaMwawule, Wadulo Fredrickhttp://hdl.handle.net/10570/112252022-12-22T08:59:04Z2022-12-01T00:00:00ZAccess to anti-hypertensive and anti-diabetic medications amongst people living with HIV in Soroti District, Eastern Uganda
Mwawule, Wadulo Fredrick
Background:
Access to anti-diabetic and anti-hypertensive medicines is one of the factors that needs to be addressed so as to ensure continuous availability of affordable quality of care to HIV clients living with hypertension and diabetes. Inability to bridge the gap of anti-hypertensive and anti-diabetic medicine access will offset the tremendous gains associated with the use of antiretroviral therapy.
Objective: To determine access to anti-hypertensive and anti-diabetic medicines amongst HIV clients.
Methods: This was a cross-sectional study that collected both qualitative and quantitative data. A semi-structured questionnaire was used to collect quantitative data from 215 HIV positive hypertension and diabetic clients. The collected data was entered into SPSS version 24, and analyzed using descriptive statistics and logistic regression to assess access to anti-hypertensive and anti-diabetic medicines. An interview guide was used to collect qualitative data from 16 key-informants (pharmacist, prescribing clinicians, dispensers, stores attendants and nurse in-charges). Collected data was transcribed, exported into Atlas.ti 22 software, and analyzed thematically.
Results: The six anti-hypertensive and anti-diabetic medicines observed were stocked-out for an average of 26.02% (16/60 days) of the days. The anti-hypertensive medicines had more stock-out days (20/60 days) compared to anti-diabetic medicines which had a stock-out duration of (12/60) days. Losartan-hydrochlorothiazide, anti-hypertensive medicine had the highest number of stock-out days (32/60) days. Accessibility was poor, with the majority 193 (89.8%) of the clients travelling more than 5Km for their medicine refills and only 86 (40%) of the clients receiving all their prescribed medicines. Medicine affordability was also poor, with majority 183 (85.1%) of the clients at risk of catastrophic health expenditure. Education level (AOR=0.245; 95% CI: 0.092-0.655; p=0.005˂0.05) was significantly associated with accessibility to non-communicable disease medicines. Supply chain practices affecting access to anti-hypertensive and anti-diabetic medicines included; inadequate technical personnel, and limited funds.
Conclusion: Access to non-communicable disease medicines is generally poor as illustrated by poor accessibility, affordability, persistent stock-outs, limited funds, inadequate technical personnel, and delayed delivery of medicines by the central medical store.
Recommendation: Government needs to strengthen health facilities in the management of non-communicable diseases by increasing access to medicines.
Key words: Access, availability, accessibility, affordability, HIV/AIDS, NCDs, HIV and NCDs.
A dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the award of the Degree of Master of Science in Pharmaceuticals and Health Supplies Management of Makerere University
2022-12-01T00:00:00ZAccess to mental health services by refugees in Imvepi Refugee Settlement, Arua District, UgandaKaggwa, Maryhttp://hdl.handle.net/10570/104912022-05-13T13:16:22Z2021-12-01T00:00:00ZAccess to mental health services by refugees in Imvepi Refugee Settlement, Arua District, Uganda
Kaggwa, Mary
Background: Uganda continues to have an influx of refugees who are exposed to multiple traumatic events that put them at a higher risk of developing mental disorders as compared to the general population. The availability of human resources, equipment, and drugs to manage mental disorders in a timely fashion hasn’t been well documented within the refugee population in Uganda.
Justification: This study aimed to examine access to the types of mental health services available for diagnosing and managing mental disorders, which will guide stakeholders on the development of easily accessible mental health interventions.
Objectives: To investigate access to mental health services by refugees within Imvepi refugee settlement.
Methods: A cross sectional study using a qualitative methodology was conducted in Imvepi refugee settlement. Participants were purposively selected using an inclusion criterion Qualitative data were collected using eight key informant interviews, six focus group discussions, ten in-depth interviews and two observational checklists. This data was then transcribed, electronically coded, and analysed through a thematic analysis using NVivo software.
Results: The study findings showed an evident lack of access to mental health services seen as unawareness of the availability of mental health services within the settlement. The lack of adequately trained mental health workers, persistent psychotropic drug stockouts as well as high transportation costs to get from one’s home to the health centres were the main concerns. Major barriers to accessing care included cultural beliefs and attitudes, stigma and discrimination, language barrier and lack of family or community support.
Conclusion: While the refugees were aware of mental disorders and had high mental health needs, poor access to trained mental health personnel and psychotropic medicines alongside poor geographic access were documented. Mental health stigma, lack of psychosocial support as well as language barrier were notable barriers to MH services. The government should provide more resources to develop better mental health policies that can close the mental health treatment gap. This will ensure increased training of mental health workers, improved availability of resources, and raised awareness within the community.
2021-12-01T00:00:00Z